Racial and Gender Disparities Among Patients with Gout
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Gout affects 8.3 million Americans according to NHANES 2007–2008, approximately 3.9 % of the US population. Gout has substantial effect on physical function, productivity, health-related quality of life (HRQOL), and health care costs. Uncontrolled gout is also associated with significant use of emergency care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared with whites, racial and/or ethnic minorities, especially blacks, have higher prevalence of gout. Blacks are also less likely to receive quality gout care, leading to disproportionate morbidity. Women are less likely than men to receive allopurinol, and less likely to undergo joint aspirations for crystal analysis to establish diagnosis, but those on urate-lowering therapy are as likely as, or more likely than, men to undergo serum urate check within six months of initiation. Although a few studies provide the knowledge related to gender and race and/or ethnicity disparities for gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race and/or ethnicity. These should be investigated in future studies.
KeywordsGout Hyperuricemia Race Ethnicity Gender Disparity Epidemiology Prevalence Genetic risk factors Adverse effects
Dr Singh is supported by research grants from the National Institute of Aging, the National Cancer Institute, the National Institute of Arthritis and Musculoskeletal Diseases, the Agency for Health Quality, and the Research Center for Education and Research on Therapeutics, and by the resources and facilities at the Birmingham VA Medical Center, Alabama, USA. The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Dr Singh has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Ardea, Regeneron, Allergan, URL Pharmaceuticals, and Novartis. Dr Singh is a member of the executive of OMERACT (an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies), a member of the American College of Rheumatology’s Guidelines Subcommittee of the Quality of Care Committee, and a member of the Veterans Affairs Rheumatology Field Advisory Committee.
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- 1.Kimball MM, Neal D, Waters MF, Hoh BL. Race and income disparity in ischemic stroke care: nationwide inpatient sample database, 2002 to 2008. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. Jul 17 2012Google Scholar
- 4.Kreatsoulas C, Anand SS. Disparity in outcomes of surgical revascularization for limb salvage. Race and gender are synergistic determinants of vein graft failure and limb loss. Nguyen LL, Hevelone N, Rogers SO, Bandyk DF, Clowes AW, Moneta GL, Lipsitz S, Conte MS. Circulation. 2009; 119: 123–130. Vasc Med. Nov 2009;14(4):397–399Google Scholar
- 8.Chang KJ, Parasher G, Christie C, Largent J, Anton-Culver H. Risk of pancreatic adenocarcinoma: disparity between African Americans and other race/ethnic groups. Cancer 2005;103(2):349–57.Google Scholar
- 13.Chu DI, Moreira DM, Gerber L, et al. Effect of race and socioeconomic status on surgical margins and biochemical outcomes in an equal-access health care setting: Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Cancer. Mar 13 2012Google Scholar
- 14.Trinh QD, Sun M, Sammon J, et al. Disparities in access to care at high-volume institutions for uro-oncologic procedures. Cancer. Feb 1 2012Google Scholar
- 21.Jeon-Slaughter H. Economic factors in of patients’ nonadherence to antidepressant treatment. Soc Psychiatry Psychiatr Epidemiol. Mar 14 2012Google Scholar
- 28.Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (full printed version). Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. ISBN: 0-309-50911-4, 782 pages, 6 × 9, (2003). http://www.nap.edu/catalog/10260.html. 2003
- 31.Institute of Medicine. 100 Initial Priority Topics for Comparative Effectiveness Research. http://www.iom.edu/~/media/Files/Report Files/2009/ComparativeEffectivenessResearchPriorities/Stand Alone List of 100 CER Priorities - for web.pdf. 2009
- 32.Cartwright-Smith L, Rosenbaum S, Mehta D. Disparities Reduction and Minority Health Improvement under the ACA. Vol 3. Washington, D.C.: The George Washington University School of Public Health and Health Services; 2011:1–6Google Scholar
- 33.Notice Number: NOT-HS-11-013. Special Emphasis Notice (SEN): AHRQ Announces Interest in Grants focused on Health Issues of Minority Women. Release Date: April 13, 2011. http://grants.nih.gov/grants/guide/notice-files/NOT-HS-11-013.html. 2011
- 39.Institute of Medicine. Women’s Health Research: Progress, Pitfalls, and Promise. 9/23/2010. http://www.iom.edu/Reports/2010/Womens-Health-Research-Progress-Pitfalls-and-Promise/Report-Brief.aspx. 2010. Accessed 07/18/2012
- 40.Healthcare Quality and Disparities in Women: Selected Findings From the 2010 National Healthcare Quality and Disparities Reports. Fact Sheet. AHRQ Publication No. 11-0005-1-EF, March 2011. http://www.ahrq.gov/qual/nhqrwomen/nhqrwomen.htm. 2011. Accessed 08/05/2012
- 41.•• Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63(10):3136–41. This is the first comprehensive population-based epidemiological study of the prevalence of gout in the US general population.PubMedCrossRefGoogle Scholar
- 49.•• De Vera MA, Rahman MM, Bhole V, Kopec JA, Choi HK. Independent impact of gout on the risk of acute myocardial infarction among elderly women: a population-based study. Ann Rheum Dis. 2010;69(6):1162–4. This is a high-quality cohort study assessing gout as a risk factor for cardiac outcomes.PubMedCrossRefGoogle Scholar
- 61.•• Juraschek SP, Miller 3rd ER, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988–1994 and 2007–2010: body mass index, obesity, and gout. Arthritis Care Res (Hoboken). 2012. This study used NHANES data and described the association between obesity and prevalent gout over time.Google Scholar
- 69.Akizuki S. A population study of hyperuricaemia and gout in Japan—analysis of sex, age and occupational differences in thirty-four thousand people living in Nagano Prefecture. Ryumachi [Rheumatism]. 1982;22(3):201–8.Google Scholar